D.A. Cook is professor of medicine and medical education, director, Section of Research and Data Analytics, School of Continuous Professional Development, director of education science, Office of Applied Scholarship and Education Science, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, and consultant, Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota; ORCID: https://orcid.org/0000-0003-2383-4633 .
J.M. Wilkinson is professor of family medicine, Mayo Clinic College of Medicine and Science, and consultant, Department of Family Medicine, Mayo Clinic, Rochester, Minnesota; ORCID: https://orcid.org/0000-0003-1156-8577 .
Acad Med. 2022 Oct 1;97(10):1554-1563. doi: 10.1097/ACM.0000000000004805. Epub 2022 Jul 6.
An essential yet oft-neglected step in cost evaluations is the selection of resources (ingredients) to include in cost estimates. The ingredients that most influence the cost of physician continuous professional development (CPD) are unknown, as are the relative costs of instructional modalities. This study's purpose was to estimate the costs of cost ingredients and instructional modalities in physician CPD.
The authors conducted a systematic review in April 2020, searching MEDLINE, Embase, PsycInfo, and the Cochrane Library for comparative cost evaluations of CPD for practicing physicians. Two reviewers, working independently, screened articles for inclusion and extracted information on costs (converted to 2021 U.S. dollars) for each intervention overall, each ingredient, and each modality.
Of 3,338 eligible studies, 62 were included, enumerating costs for 86 discrete training interventions or instructional modalities. The most frequently reported ingredients were faculty time (25 of 86 interventions), materials (24), administrator/staff time (23), and travel (20). Ingredient costs varied widely, ranging from a per-physician median of $4 for postage (10 interventions) to $525 for learner time (13); equipment (9) and faculty time were also relatively expensive (median > $170). Among instructional modalities (≤ 11 interventions per modality), audit and feedback performed by physician learners, computer-based modules, computer-based virtual patients, in-person lectures, and experiences with real patients were relatively expensive (median > $1,000 per physician). Mailed paper materials, video clips, and audit and feedback performed by others were relatively inexpensive (median ≤ $62 per physician). Details regarding ingredient selection (10 of 62 studies), quantitation (10), and pricing (26) were reported infrequently.
Some ingredients, including time, are more important (i.e., contribute more to total costs) than others and should be prioritized in cost evaluations. Data on the relative costs of instructional modalities are insightful but limited. The methods and reporting of cost valuations merit improvement.
在成本评估中，选择要包含在成本估算中的资源（成分）是一个必不可少但经常被忽视的步骤。影响医师持续专业发展（CPD）成本的成分中，哪些成分最为重要（即对总成本的贡献最大）尚不清楚，各种教学模式的相对成本也不清楚。本研究的目的是估算医师 CPD 成本成分和教学模式的成本。
作者于 2020 年 4 月进行了系统评价，检索了 MEDLINE、Embase、PsycInfo 和 Cochrane 图书馆中针对执业医师 CPD 的比较成本评估研究。两名独立的审查员筛选文章以进行纳入，并提取了每个干预措施的总体成本（转换为 2021 年的美元）、每个成分和每个模式的信息。
在 3338 项合格研究中，有 62 项研究被纳入，共列举了 86 项离散培训干预措施或教学模式的成本。报告最多的成分是教师时间（86 项干预措施中的 25 项）、材料（24 项）、行政/工作人员时间（23 项）和差旅（20 项）。成分成本差异很大，从每医师中位数为 4 美元的邮费（10 项干预措施）到 13 项干预措施中学习者时间的 525 美元；设备（9 项）和教师时间也相对昂贵（中位数＞170 美元）。在教学模式（每种模式≤11 项干预措施）中，由医师学习者执行的审核和反馈、基于计算机的模块、基于计算机的虚拟患者、现场讲座以及实际患者体验相对昂贵（每位医师中位数＞1000 美元）。邮寄纸质材料、视频剪辑和由他人执行的审核和反馈相对便宜（每位医师中位数≤62 美元）。关于成分选择（62 项研究中的 10 项）、定量（10 项）和定价（26 项）的详细信息报告较少。
一些成分，包括时间，比其他成分更为重要（即对总成本的贡献更大），因此应在成本评估中优先考虑。有关教学模式相对成本的数据很有见地，但很有限。成本评估的方法和报告值得改进。
